Case Report: Something Is Brewing.

IF 2.4 4区 医学 Q2 UROLOGY & NEPHROLOGY
Nephrology Pub Date : 2025-05-01 DOI:10.1111/nep.70051
Kate Brotherton, Bobby Chacko
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引用次数: 0

Abstract

Kava plant root (piper methysticum) is an ingredient used in ceremonial drinks throughout Pacific and South Sea Island communities. Kava is made up of kavalactones; psychoactive compounds that act as central nervous system depressants. The rare occurrence of kavalactone toxicity manifests most commonly with hepatotoxicity, and cases of myoglobinuria have been reported. Our case describes an association of significant kava tea ingestion with acute tubulo-interstitial nephritis. An 18-year-old male, without any medical comorbidities, presented with oliguric acute kidney injury after ingesting 15 cups of kava tea. His creatinine at admission was 223umolL and peaked at 96 h post ingestion at 970umol/L despite intravenous fluid administration. His urine ACR was 196 mg/mmol, with microscopic haematuria; a creatinine kinase was 780 U/L, C3 was mildly reduced (0.77 g/L) with normal C4, and the remainder of a glomerulonephritis screen was negative. He did not have any evidence of hepatotoxicity but was bradycardic with a prolonged QT interval. A urine drug screen was negative for other substances. A kidney biopsy demonstrated severe acute tubulointerstitial nephritis without acute tubular necrosis or evidence of myoglobulin-related injury. He was commenced on oral corticosteroids and had complete recovery of his kidney function after 2 weeks, without requiring kidney replacement therapy. Toxicology analysis of the kava powder identified four different kavalactones without additional substances.

病例报告:有些事情正在酝酿。
卡瓦植物根是太平洋和南海岛屿社区礼仪饮料中使用的一种成分。卡瓦是由卡瓦内酯组成的;作为中枢神经系统抑制剂的精神活性化合物。罕见的卡瓦内酯毒性表现为肝毒性,肌红蛋白尿的病例也有报道。我们的病例描述了卡瓦茶摄入与急性肾小管间质性肾炎的关系。一名18岁男性,无任何医学合并症,在摄入15杯卡瓦茶后出现少尿急性肾损伤。入院时肌酐为223umol /L,尽管静脉输液,但服药后96 h肌酐峰值为970umol/L。尿ACR 196 mg/mmol,镜下血尿;肌酐激酶780 U/L, C3轻度降低(0.77 g/L), C4正常,其余肾小球肾炎筛检为阴性。他没有任何肝毒性的证据,但心动过缓,QT间期延长。尿药筛查其他物质呈阴性。肾活检显示严重的急性小管间质性肾炎,无急性小管坏死或肌红蛋白相关损伤的证据。患者开始口服皮质类固醇,2周后肾功能完全恢复,无需肾脏替代治疗。卡瓦粉的毒理学分析鉴定出四种不同的卡瓦内酯,无其他物质。
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来源期刊
Nephrology
Nephrology 医学-泌尿学与肾脏学
CiteScore
4.50
自引率
4.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Nephrology is published eight times per year by the Asian Pacific Society of Nephrology. It has a special emphasis on the needs of Clinical Nephrologists and those in developing countries. The journal publishes reviews and papers of international interest describing original research concerned with clinical and experimental aspects of nephrology.
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